PNEUMONIA BERULANG PADA ANAK DENGAN RIWAYAT KELAHIRAN PREMATUR DAN BERAT BADAN LAHIR RENDAH

ENDY WIDYA PUTRANTO, dr. Rina Triasih,M.Med.(Paed), Ph.D, Sp.AK; Dr. dr. Nurnaningsih, SpAK

2023 | Tesis-Spesialis | ILMU KESEHATAN ANAK

Latar Belakang: Pneumonia merupakan penyumbang mortalitas global anak terbesar. Pneumonia berulang terjadi jika anak menderita lebih dari satu episode pneumonia terpisah dalam satu tahun atau tiga episode dalam masa hidupnya. Diketahui riwayat lahir prematur dan berat badan lahir rendah (BBLR) merupakan predisposisi permasalahan paru berulang pada anak usia sekolah. Pada pneumonia berulang perlu diidentifikasi permasalahan dasar dan penyerta yang menyebabakan berulangnya pneumonia sehingga dapat mengurangi mortalitas dan morbiditas penderita. Tujuan: Melihat pengaruh modifikasi gaya hidup masa pra sekolah terhadap morbiditas dan kualitas hidup secara umum penderita pneumonia berulang dengan riwayat prematuritas dan BBLR. Metode: Penelitian ini merupakan penelitian descriptive quasi-experimental qualitative. Subjek merupakan perempuan 1 tahun 7 bulan dengan riwayat perawatan karena pneumonia berulang di RSUP Dr. Sardjito. Intervensi dilakukan melalui kunjungan rumah sakit, kunjungan rumah serta edukasi orang tua. Evaluasi dinilai secara kualitatif melalui laporan orang tua, catatan medis, dan catatan peniliti selama periode pengamatan 12 bulan. Tingkat kualitas hidup dan morbiditas subjek diamati melalui frekuensi terjadinya episode pneumonia dan masalah kesehatan lain yang terkait dengan pneumonia pasien. Hasil: Variabel yang diamati meliputi anemia, frekuensi rawat inap, komplikasi dan episode ulangan pneumonia, tumbuh-kembang, pengetahuan kesehatan orang tua, perbaikan lingkungan dan kualitas hidup. Anemia yang dialami subjek saat awal pengamatan mengalami peningkatan walaupun belum mencapai kadar normal. Subjek mengalami periode rawat inap 1 kali selama pengamatan, meskipun demikian indikasi rawat inap tidak terkait dengan kekambuhan/periode ulangan pneumonia serta bukan merupakan komplikasi yang diketahui dapat disebabkan oleh pneumonia. Skrining perkembangan subjek pada penilaian paska pengamatan sesuai dengan usia berdasar penilaian menggunakan alat Denver II serta skala CAPUT. Pertumbuhan dinilai di akhir pengamatan dengan hasil subjek mengalami perawakan pendek dan gizi kurang. Pengetahuan orang tua secara khusus sulit dinilai, namun wawancara pada akhir pengamatan menunjukkan peningkatan pemahaman orang tua terhadap permasalahan subjek secara lebih menyeluruh, dan usaha untuk mengurangi faktor risiko terkait penyakit. Varibel lingkungan juga mengalami peningkatan dari sejak awal pengamatan dengan melihat penilaian meggunakan kriteria rumah sehat. Kualitas hidup dinilai menggunakan alat Peds-QL, hasil sebelum dan sesudah pengamatan menunjukkan peningkatan. Simpulan: Kecuali pertumbuhan, pasien menunjukkan peningkatan di semua variabel yang diamati oleh peniliti

Background: Pneumonia has a large contribution to the global mortality rate in children. Cases where a child has more than one episode of pneumonia in a year or more than two in his/her lifetime, are considered recurrent pneumonia. It is known that a history of premature birth and low birth weight (LBW) predisposes to recurrent lung problems in school-age children. In recurrent pneumonia, it is necessary to identify the underlying and accompanying problems that cause recurrence of pneumonia so as to reduce patient mortality and morbidity. Objective: to observe the effect of lifestyle modification during preschool on the morbidity and quality of life of patients suffering from recurrent pneumonia with a history of prematurity and LBW. Methods: This research is descriptive quasi-experimental qualitative research. The subject is a 1 year 7-month-old woman with a history of treatment for recurrent pneumonia at Dr. Sardjito. Interventions were carried out through hospital visits, home visits and parental education. Evaluation was assessed qualitatively through parental reports, medical records, and investigator notes over a 12-month observation period. The level of quality of life and morbidity of the subject was observed through the frequency of episodes of pneumonia and other health problems associated with the patient's pneumonia. Results: Observed variables in the study included anemia, frequency of hospitalization, complications and recurrent episodes of pneumonia, growth and development, parental health knowledge, environmental improvement, and quality of life. Anemia was measured by observing hemoglobin (Hb) levels at the beginning and end of the observation, which showed an increase of Hb, although not yet reaching normal levels. The subject went through 1 period of hospitalization during the observation, however, the indication for hospitalization was not pneumonia-related nor was it due to a complication that is known to be caused by pneumonia. Development screening was performed using the Denver II and CAPUT scale tools, with both evaluations indicating an age-appropriate development level. Growth was assessed at the end of the observation with the results of short stature and malnutrition. Specific level of parents' knowledge was difficult to assess, but interviews performed throughout and at the end of the observation showed an increase in parents' understanding of the subjects` main health problem more thoroughly, and regarding the efforts needed to be taken to reduce disease-related risk factors. Environmental variables have also increased since the beginning of the observation when measured using the healthy-home criteria. Quality of life was assessed using the Peds-QL tool, the results before and after the observation showed improvement. Conclusion: All observed variables excluding growth showed an increase resulting in a general improvement of life quality

Kata Kunci : recurrent pneumonia, prematuritas, kualitas hidup